Telehealth CBT to increase engagement in pain treatment among Veterans using prescription opioids

远程医疗 CBT 可提高使用处方阿片类药物的退伍军人对疼痛治疗的参与度

• 批准号: 10597542
• 负责人: LISHAM ASHRAFIOUN
• 金额: --
• 依托单位: VETERANS AFFAIRS, UNITED STATES DEPARTMENT OF
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597542
• 关键词: Address; Affect; Aftercare; Area; Belief; COVID-19 impact; Caring; Clinical Practice Guideline; Cognitive Therapy; Dissemination and Implementation; Dose; Education; Evidence based intervention; Feeling suicidal; Goals; Growth; Individual; Intervention; Investigation; Mental Health; Methodology; Modality; Morbidity - disease rate; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Pain management; Participant; Patient-Centered Care; Patients; Physical Function; Policies; Population; Post-Traumatic Stress Disorders; Premature Mortality; Public Health; Randomized; Recommendation; Reporting; Research; Resistance; Risk; Safety; Services; Severities; Stigmatization; Suicide; Symptoms; Testing; Thinking; Training; Veterans; Work; active method; addiction; alcohol use disorder; barrier to care; chronic pain; chronic pain management; comparison control; evidence base; follow-up; functional disability; future implementation; high risk; implementation research; improved; ineffective therapies; innovation; mindfulness-based stress reduction; mortality; opioid misuse; opioid tapering; opioid therapy; opioid use; opioid use disorder; pain outcome; pain reduction; pain relief; patient population; prescription opioid; prevent; psychiatric comorbidity; psychologic; psychosocial; social stigma; substance use; symposium; telehealth

Background: Chronic pain and negative consequences of long-term opioid therapy are related public health concerns associated with significant functional impairment, high psychiatric comorbidity, and premature mortality, particularly among Veterans. Clinical Practice Guidelines for opioid prescribing and pain management recommend using non-pharmacological approaches as first-line treatments. Psychosocial interventions (e.g., cognitive-behavioral therapy) have strong evidence supporting their ability to improve pain outcomes. Patient beliefs about the stigma associated with psychological interventions, opioid analgesics, ability of psychosocial intervention to improve pain among others can greatly interfere with the patients’ ability to initiate and maintain engagement in psychosocial interventions and other non-pharmacological approaches. Significance/Impact: Without a concerted effort at affecting beliefs that impede engagement in treatment, Veterans who may benefit from the treatment, will not receive it. This can result in continued risk for negative consequences associated with long-term opioid therapy and inadequate pain management. Cognitive- Behavioral Therapy for Treatment Seeking (CBT-TS) is an evidence-based intervention that directly intervenes on beliefs that act as barriers to treatment initiation and retention. By intervening on these beliefs, this study has the potential to improve engagement in psychosocial pain interventions and other non-pharmacological pain treatments, which will improve pain-related interference and functioning and reduce reliance on opioid analgesics. This study addresses VHA/VA Veteran care priorities including opioid use, pain management, and access and directly addresses priorities of the HSR&D Targeted Solicitation for Service Directed Research on Opioid Safety and Opioid Use Disorder. Innovation: The proposed study is the first application of CBT-TS for Veterans with chronic pain who are receiving opioid analgesics–a notably high-risk, treatment-resistant population. This is the first study to directly intervene on thoughts about psychosocial interventions. Specific Aims: The specific aims are to: test the effects of CBT-TS to increase initiation of psychosocial interventions for pain among Veterans receiving opioid analgesics for chronic pain (Aim 1), test the effects of CBT-TS to increase the retention in psychosocial interventions for pain among Veterans receiving opioid analgesics for chronic pain (Aim 2), and evaluate the effects of CBT-TS in improving pain and substance use outcomes among Veterans receiving opioid analgesics for chronic pain (Aim 3). We will also test the effects of CBT-TS on the initiation of and retention to other non-pharmacological pain treatments (Exploratory Aim). Methodology: Participants (N = 300) will be randomized to either the CBT-TS condition or an education control condition. Participants in both conditions will complete assessments on pain, treatment engagement, and opioid use at baseline, and 1-, 3-, and 6-months post-treatment to assess primary, secondary, and exploratory outcomes. Implementation/Next Steps: Results from this study will provide critical information on increasing engagement of psychosocial interventions for pain, which can be used to inform future implementation and dissemination efforts. The research team will work with the VHA National Pain Management and Opioid Safety office and the VHA Office of Patient Centered Care & Cultural Transformation to identify implementation and dissemination efforts. CBT-TS is undergoing current implementation research to increase mental health functioning and this effort could be expanded to also increase treatment engagement of psychosocial interventions for pain and other non-pharmacological pain treatments.

背景：慢性疼痛和长期阿片类药物治疗的不良后果与公共卫生有关 与严重功能障碍、高精神共病和早产相关的问题 死亡率，尤其是退伍军人。阿片类药物处方和疼痛的临床实践指南 管理层建议使用非药物方法作为一线治疗。心理社会 干预（例如，认知行为疗法）有强有力的证据支持他们改善疼痛的能力 结果。患者对心理干预、阿片类镇痛药、 心理社会干预改善疼痛的能力会极大地干扰患者的能力， 启动并保持参与心理社会干预和其他非药物方法。 重要性/影响：如果没有一致的努力来影响阻碍治疗参与的信念， 可能从治疗中受益的退伍军人将不会接受治疗。这可能导致持续的负面风险。 与长期阿片类药物治疗和疼痛管理不足相关的后果。认知- 寻求治疗的行为疗法（CBT-TS）是一种基于证据的干预措施， 信念是治疗开始和保持的障碍。通过干预这些信念，这项研究 有可能改善社会心理疼痛干预和其他非药物干预的参与 疼痛治疗，这将改善疼痛相关的干扰和功能，并减少对阿片类药物的依赖 止痛药这项研究涉及VHA/VA退伍军人护理优先事项，包括阿片类药物的使用，疼痛管理， 访问并直接解决HSR&D针对服务导向研究的有针对性征集的优先事项， 阿片类药物安全性和阿片类药物使用障碍。 创新：拟议的研究是CBT-TS在患有慢性疼痛的退伍军人中的首次应用， 接受阿片类镇痛药-一个显著的高风险、耐药人群。这是第一项直接 对社会心理干预的想法进行干预。 具体目标：具体目标是：测试CBT-TS的效果，以增加心理社会的启动 在接受阿片类镇痛药治疗慢性疼痛的退伍军人中进行疼痛干预（目标1），测试 CBT-TS增加接受阿片类药物的退伍军人中疼痛的心理社会干预的保留 慢性疼痛的镇痛药（目的2），并评估CBT-TS在改善疼痛和物质使用方面的作用 接受阿片类镇痛药治疗慢性疼痛的退伍军人的结局（目标3）。我们还将测试 CBT-TS对其他非药物性疼痛治疗的启动和保留（探索性目的）。 方法：参与者（N = 300）将被随机分配到CBT-TS条件或教育 控制条件两种情况下的参与者都将完成对疼痛、治疗参与、 基线和治疗后1个月、3个月和6个月的阿片类药物使用情况，以评估主要、次要和 探索性成果。 实施/后续步骤：本研究的结果将提供有关增加 对疼痛进行心理社会干预，可用于为未来的实施提供信息， 传播工作。该研究小组将与VHA国家疼痛管理和阿片类药物安全 办公室和VHA以患者为中心的护理和文化转型办公室，以确定实施情况， 传播工作。CBT-TS目前正在进行实施研究，以增加心理健康 功能，这一努力可以扩大，也增加治疗参与的心理社会 疼痛干预和其他非药物疼痛治疗。